Improvement in self-reported exercise participation with the combination of tiotropium and rehabilitative exercise training in COPD patients

Abstract

Background: Improvements in ventilatory mechanics with tiotropium increases exercise tolerance during pulmonary rehabilitation. We wondered whether tiotropium also increased physical activities outside of pulmonary rehabilitation.

Methods: COPD patients participating in 8 weeks of pulmonary rehabilitation were studied in a randomized, double-blind, placebo-controlled trial of tiotropium 18 microg daily (tiotropium = 47, placebo = 44). Study drug was administered for 5 weeks prior to, 8 weeks during, and 12 weeks following pulmonary rehabilitation. Patients completed a questionnaire documenting participation in pre-defined activities outside ofpulmonary rehabilitation during the 2 weeks prior to each visit. Patients who submitted an activity questionnaire at week 4 and on at least one subsequent visit were included in the analysis. For each patient, the number of sessions was multiplied with the duration of each activity and then summed to give overall activity duration.

Results: Patients (n = 46) had mean age of 67 years, mean baseline FEVJ of 0.84 L (33% predicted). Mean (SE) increase in duration of activities (minutes during 2 weeks prior to each visit) from week 4 (prior to PR) to week 13 (end of PR) was 145 (84) minutes with tiotropium and 66 (96) minutes with placebo. The increase from week 4 to week 25 (end of follow-up) was 262 (96) and 60 (93) minutes for the respective groups. Increases in activity duration from week 4 to weeks 17, 21, and 25 were statistically significant with tiotropium. No statistical differences over time were observed within the placebo-treated group and differences between groups were not significant.

Conclusions: Tiotropium appears to amplify the effectiveness of pulmonary rehabilitation as seen by increases in patient self-reported participation in physical activities.

Figure 1

Study design of 25-week randomized, controlled trial of tiotropium in COPD patients receiving pulmonary rehabilitation. Abbreviations: CWR, constant work exercise; PR, pulmonary rehabilitation; AQ, activity questionnaire. Notes: *Spirometry, Baseline/Transitional dyspnea index, and St. George’s respiratory questionnaire also performed.

Figure 2

Contents of activity questionnaire administered to COPD patients participating in the trial.

Figure 3

Mean (SE) minutes of activity during 2 weeks prior to each visit as reported through the activity questionnaire. Although not significantly different by statistical analysis, patients receiving tiotropium reported approximately 216 minutes more physical activity as compared with patients receiving placebo at week 25. Abbreviation: PR, pulmonary rehabilitation.

Figure 4

Mean (SE) difference in duration of activities from week 4 (prior to pulmonary rehabilitation) to subsequent visits as reported through the activity questionnaire. Patients receiving tiotropium reported on average 262 minutes more exercise at the end of the study whereas patients receiving placebo reported a gain of only 60 minutes.

Figure 5

Mean (SE) endurance times resulting from the combination of tiotropium and pulmonary rehabilitation in the subgroup of patients who completed the activity questionnaire. Patients receiving tiotropium continued to increase their measured exercise endurance during the 12-week period following pulmonary rehabilitation.